Changes in Immune-Inflammation Status and Prognosis in Pregnancy-Related Cerebral Venous Thrombosis.

Abstract

Objective: Distinguishing pathological changes from physiological adaptations in pregnancy-related cerebral venous thrombosis (CVT) is clinically challenging. This study aimed to characterize coagulation, immune-inflammation, and dehydration status in these patients and assess their prognostic value.

Methods: In this retrospective study, 120 participants were categorized into four groups: CVT with pregnancy-puerperium, CVT without pregnancy-puerperium, pregnancy-puerperium without CVT, and healthy nonpregnant female controls (30 per group). Laboratory indices were compared across groups. Neurological severity and functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) at admission, 7 days, and 3 months.

Results: Compared with CVT without pregnancy-puerperium, CVT with pregnancy-puerperium presented earlier after symptom onset and exhibited more severe neurological manifestations. CVT with pregnancy-puerperium showed higher fibrinogen and D-dimer levels than CVT without pregnancy-puerperium and healthy nonpregnant controls, but these markers overlapped with healthy pregnancy-puerperium controls. Several inflammatory markers were elevated compared with non-pregnancy groups, while neutrophil count, NLR, SII, and CRP overlapped with healthy pregnancy-puerperium controls. Elevated urine specific gravity was more frequent in CVT with pregnancy-puerperium than in healthy pregnancy-puerperium controls. Within this group, D-dimer and inflammatory markers correlated positively with NIHSS and mRS scores at admission and 7 days. Plasma osmolality > 310 mOsm/(kg·H₂O) was associated with worse neurological outcomes at 7 days and 3 months.

Interpretation: CVT during pregnancy-puerperium occurs against pregnancy-related hypercoagulability, immune-inflammatory activation, and fluid-balance changes, with overlap between pathological CVT-related changes and physiological pregnancy adaptations. D-dimer, inflammatory indices, and dehydration-related parameters may provide prognostic information for risk stratification.